For ways to help kids at risk, read Part 2 of this story.
If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (en español: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.
Anthony Orr was almost done with his high school coursework when the governor of Nevada ordered a statewide shutdown of nonessential businesses on March 17, 2020.
“He was looking forward to all of the senior activities, prom and graduation,” says his mother, Pamela Orr. But all he got was a “mini [graduation] ceremony,” with only a handful of students walking, wearing masks and at a distance from each other.
“That was the most we could do because of COVID,” she says.
Anthony graduated with honors as he had planned to, wearing a white robe and cap and an advanced honors sash, says Pamela. But he decided against going to college.
“Right now … it’s all online, and you just lose the whole college experience,” she said
Instead, he got a job working in construction. His parents thought he was doing fine. “He seemed happy to us,” says Pamela. “He seemed happy.”
But in August of last year, Anthony died by suicide.
While Pamela and her husband, Marc, struggle to come to terms with their loss, his school district in Las Vegas is trying to come to grips with the troubling statistic his death is part of.
He was one of 19 students who has died by suicide in the district since the shutdown last March. Thirteen of those deaths occurred since July.
“There’s a sense of urgency,” says Jesus Jara, the superintendent of the Clark County School District. “You know, we have a problem.”
Suicide is complex, involving layers of risk factors, including biological and environmental ones. And it’s hard to know the exact factors involved in the deaths of these 19 students.
But the sudden rise in deaths has school district officials worried that the coronavirus pandemic may have played a role. And educators and mental health care providers in other parts of the United States have the same concern.
In recent months, many suicidal children have been showing up in hospital emergency departments, and more kids are needing in-patient care after serious suicide attempts.
“Across the country, we’re hearing that there are increased numbers of serious suicidal attempts and suicidal deaths,” says Dr. Susan Duffy, a professor of pediatrics and emergency medicine at Brown University.
According to the Centers for Disease Control and Prevention, between April and October 2020, hospital emergency departments saw a rise in the share of total visits that were from kids for mental health needs.
Now, there are no nationwide numbers on suicide deaths in 2020 yet, and researchers have yet to clearly link recent suicides to the pandemic. Yet on the ground, there’s growing concern.
NPR spoke with providers at hospitals in seven states across the country, and all of them reported a similar trend: More suicidal children are coming to their hospitals — in worse mental states.
“The kids that we are seeing now in the emergency department are really at the stage of maybe even having tried or attempted or have a detailed plan,” says Dr. Vera Feuer, director of pediatric emergency psychiatry at Cohen Children’s Medical Center of Northwell Health in New York. “And we’re admitting to the hospital more kids than usual because of how unwell they are.”
She has seen a slight increase in 10-to-11-year-olds attempting, but the majority of kids she sees are teenagers.
Other places are seeing a rise in 2020 numbers compared with 2019 as well.
The number of kids with suicide attempts coming to the emergency room at Children’s Hospital Oakland, in California, in the fall of 2020 was double the number in the fall of 2019, says Marisol Cruz Romero, a psychologist and the coordinator for the hospital’s behavioral emergency response team.
At Riley Hospital for Children in Indianapolis, the number of children and teens hospitalized after suicide attempts went up from 67 in 2019 to 108 in 2020. And October 2020 saw a 250% increase in these numbers over the previous October, says Hillary Blake, a pediatric psychologist at the hospital.
Psychiatrists and other doctors who work with children say the pandemic has created a perfect storm of stressors for kids, increasing the risk of suicide for many. It has exacerbated an ongoing children’s mental health crisis — suicide rates had already been going up for almost a decade among children and youth.
The problems brought on by the pandemic, they say, only highlight the weaknesses in the mental health safety net for children — and point to an urgent need for new solutions.
“The stories that we hear day by day in the emergency department really speak to us about the level of difficulties, the layers of traumas and the real problems that families are facing,” says Feuer.
Loss of critical in-person support services
Many young people, like Anthony Orr, have no diagnosis or known history of mental illness when they start struggling with thoughts of suicide.
But the children who are most vulnerable right now, says Duffy, are the ones with underlying physical or mental illness, because the pandemic has disrupted in-person services they relied on in communities and at school.
“They have difficulties with their mood or difficulties with learning or socialization or medical issues,” says Feuer. “And now you have other layers of difficulties on top of that. These are the kids we see in real hopeless moments.”
Before the pandemic, many of these children were “relatively stable in the community with outpatient resources,” says Duffy.
For example, Duffy saw a 13-year-old in her ER recently who had underlying anxiety and depression. The at-home and in-school services she relied on had been suspended.
Without those supports, her mental health worsened and she started to fall behind at school, says Duffy. The girl turned to self-harm and eventually attempted suicide.
“It was her [older] teenage sister who found her in the bathroom and who called their mother, who had to leave work,” says Duffy.
Feuer recalls seeing a 14-year-old last fall who began to struggle at school after developing a medical issue that hadn’t been properly diagnosed because of pandemic-related delays in care. He was in constant pain and couldn’t focus on schoolwork, she says.
On top of that, the pandemic had taken away his access to sports, “which was his world and life,” says Feuer. “And then he looks at you and says, ‘What’s the point? What do I have to look forward to? You tell me, what do I have to be hopeful about?’ “
Falling off the radar
Another layer of risk right now is that virtual schooling has made it much harder for teachers and school counselors to identify and help students who are struggling.
When Nevada shut down last March and the Clark County School District switched to virtual learning, Colleen Neely, a counselor at Shadow Ridge High School, on the outskirts of Las Vegas, tried her best to stay connected with her students by email.
But it wasn’t as easy as being in the school together, she says.
“There are just extra barriers,” says Neely. “We’re not there just in passing, or they can’t go to their teacher and be like, ‘Hey, I want to see my counselor.’ They can’t stop in at lunch. They have to make that effort with an email or clicking on a computer to make an appointment.”
In May, Neely’s supervisor called her to give her the news that one of her favorite students had died.
“He was a smart … shy kind of kid,” says Neely. “Very kind, polite and respectful.”
She was used to seeing him every day as he would stop by her office to check in. She says he had been homeless for a while and had some emotional struggles too. The school had eventually found him a family to live with.
And he’d been doing really well when the school switched to virtual learning, says Neely.
“He was passing all of his classes, going to earn the highest-level diploma that we offer at our school. So he was in a really good place,” she says.
She was devastated to hear that he’d taken his own life.
